This story is by Amina Juma and her team’s improvement project to reduce incidence of physical violence within an eight-bedded in-patient assessment unit for adults with learning disabilities and mental health difficulties on Preston Ward at the Kingswood Centre in north west London.
Preston Ward: Reducing incidence of Physical Violence
We knew we had a problem with the number of incidents of physical violence on the ward. Our patient safety incident data from datix was showing us that we had a high rate of incidence that we wanted to reduce. Therefore, with the support of our coach, Jack Pooler, we chose to set our aim to reduce the number of episodes of physical violence on our ward by 50% by July 2022. As a team, we knew we wanted to do this work to create a safer environment for service users and improve staff morale and confidence in managing risk both in and out of the ward. In the scoping phase of this project we knew we wanted to understand what matters to our service users, carers and our staff. This information informed and shaped our project.
We iteratively tested multiple change ideas through PDSA cycles, which helped us to understand what worked well and what we needed to adapt. Based on this, we found that safety huddles by the ‘whiteboard’ at the beginning of our shift had a significant impact on team member’s situational awareness. This increased understanding of key priorities of the day is something that we value. In addition, other change ideas that we have successfully tested have been the uses of safety crosses that are shared on our team’s Quality Improvement project board.
One of our change ideas co-designed with our service users was to introduce smart televisions to increase individual choice and increase communal activity that bring service users and staff together. One service user fed back:
“I am so excited to be watching my favourite TV programme now, I will look after this television and not damage it like I did the last one”
We have also commenced multidisciplinary safety huddles were datix safety data is reviewed and the sharing of learning from incidents occurs. These huddles have also been effective in sharing learning and exploring challenges relating to our improvement efforts. The project team also fed back:
“This project has brought cohesion to the team as we all have the opportunity to participate and it feels like we all own this project. In addition, with the increased visibility of our project, other professional groups are becoming interested in participating in our improvement work. This multidisciplinary approach is great to see and is bearing positive results.”
As team we are very proud of our run chart data on LifeQI (on-line quality improvement platform) and have had a shift in our data towards improvement in the number of episodes of physical violence in September and October with our current median of two episodes per week. We are also very proud of the fact that we have reduced the weekly median number of physical restraints from seven to one since we commenced this improvement project.
Going forward we want to continue to build on these successes to achieve sustained improvement in the reduction of physical violence and aggression in our ward.
If you would like to know more specific details about this project then please see this team’s poster submission on Trustnet or email us at cnw-tr.improvementsupport@nhs.net and we will be very happy to connect you with the Preston Ward manager, Amina Juma.